Abstract
Background and Aim: The relationship between liver cirrhosis and Helicobacter pylori (H. pylori) is a debatable matter. The aim of this study is to evaluate the possible association between H. pylori infection and liver cirrhosis.Methods: A single-center prospective cohort pilot study of 558 patients with cirrhosis was followed up for 1 year. Serum C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), nitric oxide (NO), vascular endothelial growth factor (VEGF) levels and Fecal H. pylori antigen were evaluated by enzyme-linked immunosorbent assay (ELISA). All patients with positive H. pylori were treated and then followed up for 3 months. Participants with eradicated H. pylori were followed up for one further year.Results: H. pylori-positive patients (48.4%) were associated with increased levels of serum CRP, TNF-α, IL-6, NO, and VEGF, as well as increased incidence of varices, portal hypertensive gastropathy, gastric antral vascular ectasia, hepatocellular carcinoma (HCC), spontaneous bacterial peritonitis, hepatic encephalopathy, portal vein thrombosis (PVT), and hepatorenal syndrome (all P < 0.05). Multivariate analysis models revealed that the presence of H. pylori was an independent risk variable for the development of portal vein thrombosis and hepatocellular carcinoma (P = 0.043, P = 0.037) respectively. After treatment of H. pylori infection, there was a significant reduction in all measured biochemical parameters and reported cirrhotic complications (all P < 0.05).Conclusion: Incidence of PVT and HCC development increased with H. pylori infection through increased inflammatory markers and vascular mediators. Moreover, its eradication may reduce the incidence of these complications.
Highlights
Helicobacter pylori (H. pylori) is a pathogenic bacteria that affects the human gastric tissue, and it is the most common etiology of peptic ulcer and gastritis [1]
It has been hypothesized that H. pylori could be a risk factor for many liver disorders, for example, nonalcoholic fatty liver disease, isolated hypertransaminasemia, and portosystemic encephalopathy [3,4,5,6]
While the presence of Helicobacter species or H. pylori has been reported in hepatic tissue samples from patients with different hepatic disorders [8,9,10,11,12,13,14], a direct association of H. pylori in the development of cirrhotic complications in patients with liver disease has been postulated with a less strong evidence [3]
Summary
Helicobacter pylori (H. pylori) is a pathogenic bacteria that affects the human gastric tissue, and it is the most common etiology of peptic ulcer and gastritis [1]. As mentioned in the literature review, the association between liver diseases and H. pylori has been discussed and still remains a matter of debate [7]. While the presence of Helicobacter species or H. pylori has been reported in hepatic tissue samples from patients with different hepatic disorders [8,9,10,11,12,13,14], a direct association of H. pylori in the development of cirrhotic complications in patients with liver disease has been postulated with a less strong evidence [3]. The purpose of this study, is to evaluate the possible association between H. pylori infection and liver cirrhosis. The aim of this study is to evaluate the possible association between H. pylori infection and liver cirrhosis
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